Fighting HIV in Miami, one dirty needle at a time

Jose De Lemos, 53, and Hansel Tookes, M.D., a University of Miami medical resident, outside of Jackson Memorial Hospital after a recent visit. De Lemos, who has HIV, is being treated by Tookes.

(Part II of a III Part Series)

By Amy Driscoll, Miami Herald

Advanced HIV Cases

Tookes, a 35-year-old internist, took on the against-the-odds fight for a Needle Exchange Program because he felt he had to. Too many people were coming through the doors of Miami-Dade’s public health system with advanced cases of HIV in an era when the virus that causes AIDS is generally treated as a disease you live with, not one that kills you. Injection drug overdoses were rising, too.

The doctor knew getting people into treatment earlier could make a huge difference in their lives and reduce infections of others. (“I’m trained to look for public health solutions,” he said.) A needle exchange was a step toward that goal. Florida had never allowed a needle exchange program before. But why couldn’t that change?

His grandmother, Gracie Wyche, had set the bar high in his family. She was a pioneering Black nurse in Miami who started out in the then-segregated wards of Jackson Memorial and eventually became a head nurse, concentrating on a mysterious illness in the 1980s that later became known as AIDS. Tookes became even more interested in public service during his undergraduate work at Yale University and a stint as an investigator for Project Aware, an HIV testing/counseling clinical trial at UM. He got a public health degree at UM, and then his medical degree.

Now a third-year resident who does his research through UM’s division of infectious dis-eases at the Miller School of Medicine, Tookes said his grandmother’s work set him on this path. “She inspired me,” he said. “There’s just a long history of service on both sides of the family.”

The HIV numbers drove him, too. In 2014, the Miami-Fort Lauderdale region ranked No. 1 in the nation by the U.S. Centers for Disease Control and Prevention for the rate of new HIV infections in areas with more than 1 million people. That year, Miami-Dade County had 1,324 new HIV cases, the CDC said, while Broward had 836 cases. Statewide, in 2014, the Florida Department of Health said 110,000 people were diagnosed and living with HIV. People are still dying of the virus. In the United States, 6,955 people died from HIV and AIDS in 2013, according to the CDC.

Tookes saw the toll up close, in the examining room. A man in his 40s who had sex with men, no body fat and pneumocystis pneumonia, a disease often associated with AIDS — who didn’t know he’d probably had HIV for years. An impoverished woman from Liberty City with a debilitating bacterial infection from a severely compromised immune system, who had never before been tested for HIV. Or a young man diagnosed with HIV a few months ago who revealed to Tookes during a clinic visit that he uses intravenous methamphetamine.

“Everything with this issue — all of the advocacy that we did for this policy — was to fix an issue that we were seeing in everyday clinical practice. … I think as physicians, we had a duty to intervene,” Tookes said. “We knew there was something we could do for these people to help them from getting so sick, and so we decided to fight for it.”

He faced deep suspicion a-bout the idea going back to the just-say-no 1980s. Although needle exchange programs have become increasingly com-mon even in GOP-controlled states — Indiana’s governor and now Republican vice presidential candidate Mike Pence changed his position last year after an outbreak of HIV and hepatitis C — Florida remained a holdout. Some lawmakers continued to believe that giving addicts clean needles amounted to government-endorsed drug use.

Starting in 2012, Tookes — backed by a coalition including the Florida Medical Association, the Florida Hospital Association and the Miami-Dade State Attorney’s Office — tried to make headway with lawmakers. When he hit the wall of opposition, he didn’t give up. He didn’t get disillusioned or cynical. He tried again. And again. In the legislative sessions of 2013, ’14, ’15.

Then 2016 came along. The heroin epidemic created a whole new conversation around the issue of injection-drug use.

This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.

This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a non-partisan health care policy research organization unaffiliated with Kaiser Permanente.